Will I Need Surgery for My Ulcerative Colitis?

Medically Reviewed by Minesh Khatri, MD on January 27, 2020

Surgery can often cure long-term ulcerative colitis (UC), but it's not for everyone. Your doctor may suggest an operation if your UC is severe and you don't get enough help from other treatments, like medicines and changes in your diet. It could also be an option to help you prevent colon cancer.

There are two procedures. Both are major surgery on your digestive system. Get to know the details of each operation, and talk with your doctor about which one they recommend for you.


What it is. In this procedure, also called IPAA (ileal pouch-anal anastomosis), your surgeon removes the part of your bowel that's causing trouble, including your colon and rectum.

They'll use the end of your small intestine, called the ileum, to make a pouch inside your body that collects waste. Then they'll connect the pouch to your anus.

What are the side effects? The pouch can become irritated or inflamed, which is called pouchitis. Antibiotics usually take care of the problem. 

What to expect after the surgery. Because muscles around your anus aren't affected, you'll eventually be able to get rid of food waste the usual way, on the toilet.

At first, you'll need to wear a bag outside your body over a stoma -- a surgical hole in your belly connected to your intestine -- to remove the solid waste, while your new internal pouch heals.

You'll still go to the bathroom often, but probably not as much as before the operation. In time, you may go even less frequently.

You may find that you can eat more foods than before you had the surgery, or you may feel better with your familiar foods. Try items one at a time to see how you feel. And don't eat within 3-4 hours of bedtime.

Give your recovery some time. Most people eventually get back to all of their usual activities. In the meantime, if you find that you tire out faster than usual, remember that you're healing from the operation. You will need a second surgery to eight to 12 weeks later to reverse the temporary ileostomy and reconnect your small intestine.

Your doctor can let you know about any limits you should have during your recovery. For instance, women who get the surgery should avoid sex for 6 weeks.


What it is. The surgeon removes your colon, rectum, and anus. This operation reroutes part of your digestive system so food waste goes from your small intestine straight out of your body through a hole, or stoma. It collects in an external pouch, or bag, that's connected to the outside of your lower belly. You change it when it gets full.

Your ileostomy may be permanent, or you might get it as a temporary measure before you get a J-pouch.

What are the side effects? As with any operation, there is a chance of infection.

What to expect afterward. You should be able to go back to many of your daily activities in about 4 to 6 weeks. You may need more time before you can do things that are physically hard, like heavy lifting.

You can wear your regular clothes and even shower with the pouch on. It shouldn't show under your clothes or affect how you dress, but you might want to keep tight belts off of the stoma. If the bag is on securely, no one should smell any odors. 

It will probably take time to adjust to living with the stoma and the ileostomy system. But you should get used to emptying the pouch with a little practice. 

When you eat:

  • Chew your food well.
  • You may need to limit fiber, such as popcorn, foods with seeds, nuts, and raw veggies.
  • Avoid gassy foods such as soda and beans.   

You can feel confident about being back in your regular routine. Once you've healed, you can do everything you did before the operation -- go to work, play sports, have sex. But it is an adjustment, so talk to your doctor about how you can handle this change.

Show Sources


Crohn's and Colitis Foundation of America. "What is Ulcerative Colitis?" "Surgery for Crohn's Disease & Ulcerative Colitis."

Carne, P. Clinics in Colon and Rectal Surgery, February 2004.

Kirat, H. Clinics in Colon and Rectal Surgery, December 2010.

National Institute of Diabetes and Digestive and Kidney Diseases: "Ostomy Surgery of the Bowel."

University of California San Francisco Medical Center: "Special Concerns for People With J-Pouches."

University of Pennsylvania Health System: "Patient & Family Guide to Ileal J-Pouch Anal Anastomosis (IPAA) Surgery."

American Cancer Society: "What is an ileostomy?"

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